Use of ECT in Major Vascular Neurocognitive Disorder withTreatment-Resistant Behavioral Disturbance following an AcuteStroke in a Young Patient

The following case describes the utilization of bitemporal ECT as a treatment of last resort in a 47-year-old woman with profoundlytreatment-resistant behavioral disturbance poststroke. The use of ECT led to improvement in symptoms sufficient for dischargefrom an inpatient psychiatric unit to the nursing home. Neuropsychiatric sequelae of stroke include poststroke depression, anxiety,mania, psychosis, apathy, pathological laughter and crying, catastrophic reaction, and mild and major vascular neurocognitivedisorders. Behavioral disturbance is common and may pose diagnostic and therapeutic difficulty in the poststroke patient. Inmost cases, first-line treatment includes pharmacologic intervention tailored to the most likely underlying syndrome. Frequentuse of sedating medications is a more drastic option when behaviors prove recalcitrant to first-line approaches and markedlyaffect quality of life and patient safety. ECT is generally safe, is well tolerated, and may be effective in improving symptomsin treatment-resistant behavioral disturbance secondary to stroke with major neurocognitive impairment, as suggested in thiscase